Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery?

Endoscopic surgery has been extensively used for many surgical conditions and has gained acceptance as an alternative and less invasive approach to open surgery. However, minimal access endoscopic techniques have yet to be translated into mainstream clinical practice in breast surgery. More recently, technical innovations have made it feasible to conduct endoscopic breast cancer resection, with or without breast reconstruction, through wounds inconspicuously hidden in the axilla and periareolar region. Several clinical trials have now been conducted to demonstrate technical feasibility, assess safety and provide follow up data regarding oncological success of endoscopic breast surgery. This primary aim was to critically evaluate the literature in order to determine the oncological and cosmetic efficacy of endoscopic breast surgery. A systematic review was conducted using Medline, Ovid and Embase to identify original data from studies of endoscopic breast surgery. Initial results have demonstrated that endoscopic breast surgery is safe and technically feasible. Early data suggests that it is possible to achieve disease control with high rates of overall survival and low rates of local relapse recurrence and/or distant metastases. However, the absence of level I randomised clinical evidence currently precludes a recommendation that endoscopic breast cancer surgery is capable of achieving equivalent oncological outcomes to open surgery.